Sunday, April 26, 2009

Cholesterol: This week I received the results from my recent physical related blood work. All was exceptional and in exploring my numbers, I came across the Adult Treatment Panel III guidelines of the NHBLI. It was fascinating and I encourage you all to review the summary document and the heart disease death risk calculator as well. The guidelines are meant for physicians to use to determine how low a person’s LDL needs to be based on how many risk factors the person has. The guidelines do have what they call a therapeutic lifestyle change or TLC diet which calls for reductions in saturated fat and an increase in fiber. However, if one has several risk factors and cannot get their LDL down to a very low number with diet and exercise, the panel recommends starting a statin medication. This can be disconcerting to someone who’s LDL is not high, but when other risks are present that LDL number can increase the chance of early death and that is what the ATP III is designed to prevent. Do check it out. Though I am anti medication in general, I am open to it when it can prolong quality life years. http://www.nhlbi.nih.gov/guidelines/cholesterol/atglance.pdfhttp://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=profColorectal Cancer Screening: A story that caught my attention this week reported on research that suggests certain lifestyle factors could do more to prevent colorectal or colon cancer than the cancer screen that I have been vocally dreading in the pages of this blog. And I can assure you, if additional research supports these findings and I can adopt all of the suggested life suggestions, I will forgo the colonoscopy. Here is the scoop: the research was done in Britain on the British population and in fact, they do not address the colonoscopy but the fecal occult blood test. As they do not mention the other test I wonder if they too recommend it for the general population when they reach age 50. Still, what they report is important. If the up tick of obesity in their country can be halted by having the current population limit their red and processed meat intake, increase exercise to five 30 minute walks a week, increase fruit and vegetables to five servings a day and have only one or two drinks a day, (women-men), then there would be a significant reduction in this disease. These same recommendations are made to reduce cases of heart disease and cancer both in the UK and the USA. I have no changes to make, but you may, so make it a priority because YOU are.Can Food Change Your Brain? As a tobacco treatment specialist, I know that nicotine can physically change the brain and as a runner, I know that exercise can at least acutely affect neurotransmitters in the brain, so the headline than claims a high jacked brain related to overeating did not seem sensational to me. However, when reading the article that does in fact relate overeating to the activation of the reward pathway in the brain and the release of dopamine, I sort of frowned. Dopamine can be released by smoking and by exercise and by eating and by sex. The high jacking comes when the brain thinks that it absolutely must have something to survive when this is not true. For example, we do not need nicotine or chocolate to keep breathing. A former FDA chief has written a book regarding chronic over eating and how one can learn to control this and maintain a normal weight. Some fault for the condition is attributed to the food industry and its manipulation of fat, sugar and salt in our foods. The book is titled The End of Overeating.Obesity Surgery: I hate this treatment option because I think it is insane. My very opinionated spiel is that if a person is willing to drastically change the shape of their visceral organs and eat meals that are no bigger than ounces for the rest of their life why can they not eat less and move more? That is the opinion part, but my health educator self is concerned for the complications that can occur with any of the bariatric surgeries. A study this week, where a researcher reviewed outcomes of over 19000 procedures, compared death and complications between patients at a bariatric “center of excellence” to hospitals without such a designation and found that the centers for excellence did not have better outcomes. In fact, 1.7 of the patients at the “excellent” centers died, where as only .09 at the others. There is evidence to support that the surgery can reduce adverse health outcomes that are related to obesity, I only contend that there are safer ways to loose weight.

Friday, April 17, 2009

Poly pharmacy: This term generally refers to situations when a person is taking several medications to treat more than one disease. I am thinking of it today in regards to polytherapy or taking multiple meds for the treatment of one disease. This has become almost the standard in regards to blood pressure, diabetes and cholesterol as well as some mental illnesses. For example, we have commercials promoting the drug Abilify as an adjunct to a persons existing antidepressant regimen. When I hear the ad voice over that suggests the depressed person ask their doctor about adding a medicine if the one they are on is not helping I wonder why medicine is the first choice for treatment at all. But this is the way the world is now and the next disease that will be addressed with two or even three concurrent meds is tobacco dependence. Research supports that combination medications used over the long term will significantly increase quit rates. Sometimes the medications are nicotine based and I have to wonder why we don’t give alcoholics some type of transdermal patch to treat their condition.Simple Rule for Healthy Eating: I can only take credit for sharing Michael Pollan’s advice with as many people as I can not for saying this myself, except I have made many of these same suggestions and have certainly seen the proof in science. The simplest thing that he says, I will repeat verbatim. “Eat food, not too much, mostly plants.” This is of course the Mediterranean diet. Mr. Pollan cautions against eating things that contain ingredients that one cannot pronounce and items with more than five ingredients and foods that will never turn bad. He advises that you always leave the table a little hungry, which you will if you eat small frequent meals. He does have one recommendation that I had not thought to make and it is a pearl. He tells us not to get our food from the same store that we purchase our gasoline. Eat, eat whole food, don’t stuff yourself, and let me add, move your body every chance you get!Pharm Industry Update: A couple of interesting notes out this week. The first is that the advertising that I so loathe is actually being curtailed for the first time in many years. A chart in the WSJ shows the amount spent trending up starting in 2002 and finally dropping in 2008. Be aware, the yearly expenditures were no less than 4 billion a pop. They are now spending less on direct marketing to consumers and they are spending less on marketing to health care professionals. They are laying off some of the sales staff. This is not good for employees but it may allow us to get back to medicating patients because they really need it and not because the drug company said they did. What is not positive in the recent news is that the companies are increasing the price for many medications. One reason offered is that the companies are trying to fill the coffers before some of their big names go generic.Good Fat You May Already Have: This story didn’t stay around long, but it was an interesting report on a research studies that were released this month on another type of adipose tissue. More often we hear about visceral fat vs subcutaneous fat. Now we have something, well we always had it, but it is brown fat. Brown fat appears to be very different from the other kind, which I believe is white. Scientists were aware of the fat but thought that it was more often found in children and when in adults it didn’t really do much. But it does. It is an active tissue which means it burns calories whereas white adipose tissue stores energy and is inactive. One of the studies noted that the brown tissue becomes active to generate heat, to keep a person warm. Here is the irony. We want more brown than white fat and guess who has the brown fat… young, thin, women. No doubt some biotech company is at this moment diligently trying to find something to help obese people turn their white fat to brown.Foods that Make You Want to Eat More: Ah, reread that caption will you. They do not make you eat more, but want to eat more. You control whether or not you eat! I say this because some studies have suggested that eating foods with artificial sweeteners or drinking diet sodas leads to weight gain. It only leads to weight gain if you consume more calories than you need. I drink a diet soda a day and I also eat the right amount of calories for myself… on most days anyway. Still, an article in the WSJ’s Health Journal this week notes some foods that do seem to trigger appetite. The reason is one you have heard before.. the consequences of eating simple carbs. Spike your blood sugar and pay later by being hungry, cranky and metabolically disadvantaged. Here are the foods listed as appetite generators. Bread, sweets, juice, pasta, wine or beer before dinners and artificial sweeteners. To avoid this phenomena, eat foods that are complex and that have a fiber component… for example , eat an apple instead of apple sauce, eat an orange over orange juice OR, be very mindful of the amount of calories you are consuming!

Friday, April 10, 2009

Triglycerides: Having high triglycerides can be an independent risk factor for heart disease. Heart disease can of course lead to premature death. Unfortunately, there is a growing prevalence of this condition in America which is associated with the obesity problem that we have. There has been a push by some, I am guessing the pharmaceutical industry, to use statin therapy to lower triglycerides, but a recent study does not support that recommendation. Instead, when a person’s level of this blood fat is between 150 and 500, known as hypertriglyceridemia, changes in diet and activity level should be recommended by the treating physician. This is a serious issue. I have not had blood work since 2005, but I had it today! So stay tuned for the present. My last level was in the 80s.What? With sales slumping at most clothing stores, eclectic boutiques are looking for ways to get customers in and to keep them around for a while. I read in the WSJ last week that several were offering beer, wine and cocktails. My first and continued reaction is this, the LAST thing I want to do before I try on a pair of jeans is drink a beer!High or Low Fat,Carbs,Protein: Instead of a randomized clinical drug trial, researchers who published their study in a peer reviewed journal, Cardiosource, placed over 800 overweight and obese persons into 3 separate diet groups. What they found was weight loss occurs when less calories are consumed (everyone sure hates to hear that), but cholesterol levels were lower in the group that ate less saturated fat.Garadasil: One of my list serves contained an article on recommendations for this vaccine. Because Gardasil is new and in my opinion controversial, I read the article. There were a few points that I would like to iterate. There are 4 strains of HPV addressed by this vaccine. Two of them are responsible for 70% of the HPV that can lead to cervical cancer and two are responsible for 90% of the strain that may lead to genital warts. If a person has been exposed to part of these four strains (there are many more strains) but not all, there may be some therapeutic benefit from getting the vaccine. There is no benefit if a person has been exposed to all four. Thus the vaccine is best for persons not yet sexually active. HPV is the most common of the sexually transmitted diseases with current prevalence at about 26%. The article that I read was written by pharmacist Laurie Briceland. BTW, vaccine or no, Pap Smears can prevent cervical cancer.Readmissions: The Government and it’s Centers for Medicare Services or CMS, did some research into costs of care for its Medicare recipients. Of concern is readmission to the hospital within 30 days of discharge. The study found that billions of dollars could be saved if this rate of readmissions could be lowered from the current 20%. What is considered the main cause of these unplanned readmissions is lack of adequate follow up care. Discharge planning was one of my roles in a past career and at my hospital every patient had to be scheduled with their PCP after discharge. Many patients did not keep their appointment and the cause of that warrants further investigation. Some issues of which I am aware is availability of doctors, long wait times, transportation issues, and Medicare visit costs. I must add that at many hospitals there is pressure to “get the patient out of there.”Obesity Epidemics Main Cause: I have seen this before but when I saw it on Sunday I thought, you know, that is it right there. Electric Bicycles. No not mopeds, bicycles with engines. Now General Motors, whom I thought could not make any more mistakes, wants to expand its relationship with Segway Co. A new vehicle is being produced that can pretty much obviate walking. This new rideable device will be called PUMA. That stands for Personal Urban Mobility and Accessibility. I cannot swallow this. We are overweight and our environment is polluted for one very significant reason… we do not walk anywhere. So for those of us who are able to walk, i.e. not paralyzed, here is the personal mobility device I would like to promote; LEGS.

Friday, April 3, 2009

Migraines and Me: Today I do not have a headache…. I have not known such gratefulness since I experienced severe back pain, which also resolved. A long time ago, pre 2002, I had a migraine on Christmas Day… my first. After that experience I would always be clear in stating that I had a severe headache or even a submigraine, from time to time, but having had a migraine I would NEVER mis categorize a headache. Since that Christmas Day I may have had two more migraines and I have never sought assistance for them as I am determined NOT to be someone who suffers from migraines. That changed this week. I have had more migraines in the last ten days than in my over 40 years of life. I did everything I usually do and could not barrel through them. I saw my doctor. Good news is that he believes something in the environment triggered a severe episode that just cascaded into migraine after migraine with remission but not resolution. He did say we had to break the cycle. He did say we had to do it with a medication. Readers know that I do not do prescription medication. And my bigger fear is (was) to become someone who has to keep medication on hand. He believed that this is or was an isolated incident and I trust him in that. I also appreciate how he presented the options, there were three. He discussed cost, side effects and other people’s responses. I accepted a sample of a medicine by Pfizer… I know, that alone almost killed me, but I was beyond my capacity to withstand any more pain. I am a distance runner.. I CAN endure pain and thus it was THAT bad. So I took my samples home and I took the first pill and lied (or laid) there two hours waiting for it to work. I was under the impression that I was going to have almost immediate relief and feel like I took morphine or something. HA. The pain trickled away, it did not stop abruptly. That was Wednesday night. Thursday I was traumatized and scared to tears that it would come back… today I feel somewhat more confident. I am writing mostly to address the prescription drug issue as I continue to think pills should be a very last resort, that they are entirely too expensive and the side effects are not to be taken lightly. That being said, Wednesday I did not read the label of my new medicine. The doctor warned of GI upset and that I thought would be tolerable. I can tell you that as I lie there I considered that this prescription drug could kill me and I did not care. So maybe this experience offers me a little empathy to why some people risk horrible side effects when they take meds though it does not change my belief that wherever possible prevention of disease is the better “medicine”.Attention Parents:Childhood Obesity: I am taking a course through the University of Tennessee for my health educator credential (CEUs) and have a few interesting pearls to share with you. The course is taught by MDs, RDs, and PhDs. Dr. Velasquez-Mieyer noted that what we see in adults started as children. Dayle Hayes, M.S., R.D. encourages people who are concerned about children’s nutrition to join their school health advisory committee, also known as SHAC. And Dr. Hollie Raynor offers important strategies for dealing with the treatment of obesity in children. Dr. Raynor is by far my favorite lecturer in this series. She and her team do provide intensive treatment to overweight elementary school aged children. They do this within the university setting and thus can apply rigorous research protocols as well. There are things in her methodology that you can apply at home right now whether or not your child is obese. This includes focusing on behaviors. For example, she does have young children weigh themselves (not a standard thing you should do, this is for children in a targeted obesity treatment program) but when there is a 2 pound weight loss, for example, she offers positive reinforcement and encourages the child to pinpoint what behavior may have led to that. Which of the actions is the cause of the weight change - less TV time, more walking or riding the bike, or even more green foods then red foods (my favorite traffic light program!)? It is also part of this family centered program that the parents adopt the SAME behavior as the child. If the child has to eat less of the red foods, so does the parent! Parents must also increase the physical activity. Even better, she talks about covert and overt food restriction. Dr. Raynor prefers covert. Covert restriction involves not having the food in the house at all. Overt is like buying ice cream but telling the child they can’t have any. This might lead to tantrums and all kinds of issues, but if the food isn’t there it isn’t there! Sure they might eat it somewhere else, but they aren’t eating it at home. Another good point she made was that in children we want to change the food preference. So there may be a less bad option of a food, say baked chips instead of regular chips, but they are still chips. Don’t serve chips! Changing preferences. Serve wheat and or whole grain bread, no other kind. I could go on. Ok one last thing. We want kids to be more active, so TVs out of their bedrooms and action toys available. If they like to ride their bike, then make sure the tires are good and the bike is easily accessible.Generics: Okay, even though Pfizer appears to have helped me out, I am not going to abandon my quest for fairness with pharmaceuticals. I am happy then to report that there are a few versions of bills circulating in the US Congress which attempt to stop drug companies from paying generic makers to HOLD OFF on the release of their cheaper versions. Often times during this extension, the brand name company works to tweak the medicine in question, as I have described before, perhaps making it a long acting type or a liquid type and then convincing the user that they need the new kind. So months later the generic of the medicine you have taken for years is available but your doctor has switched you to the extended release formula and the generic doesn’t come in that. What a bunch of bunk. I hope this is addressed by our legislators.HFCS: High Fructose Corn Syrup is bad. We don’t really need to get into the hows and whys, but it is a highly processed thing and is worse than sugar, even simple white sugar. I bring it up now because I made a comment at work this week regarding one of my favorite portion controlled snacks. These sugar wafer cookies made and or marketed by a Mexican company are lower in calories than other brands. Four of the wafers (chocolate, strawberry or vanilla) have 120 calories. They are long and thin and compared to other sugar wafers, even ones that say they are sugar free, these have less calories. I think the label must be wrong. Still, one of my awesome coworkers (many of my coworkers are indeed awesome) said it is because the other types have HFCS and that is more caloric. HMM. Intuitively I think that the corn syrup is just a big vat of sticky sweet stuff and way high in cals yes, but wouldn’t that mean you’d use less of it than you would sugar. I did check my cookie label, and YES Beth is right so far… NO HFCS. Now, let me do a little Google check and see if I learn anything to uphold the theory…. BRB>>>>>>>>>>>Oh My Gosh. I should have seen this coming…now HFCS is still evil, but it does not have more calories than sugar, in fact it has less. Sugar is a carb with 4 kcals per gram while HFCS has 3/g. So I started looking up all the sugar wafers, esp. the sugar free ones, which mine are not. The culprit isn’t the sugar it is FAT. Mine have 4g of fat per serving whereas the Voortman and Murray…have 8g. That is it right there; they replaced the sugar with fat. I will be damned. Oh and be assured it is not monounsaturated fat. Now I am not claiming my Mexican sugar cookies are a green (GO) food, but that I like sweets too and these are lower in calories. YEAH! Remember neither fat free nor sugar free means calorie free and yes, there is more calorie per gram of fat than sugar – 5 more to be exact.

Okay, let’s do some cooking. A Stir Fry Volumetrics Dinner is featured today.

That will bring us to today’s cooking video. The point of these videos is to assist you in eating food, lots of food really, without adding non nutritive and even disease promoting extras.. like saturated FAT and sugar.BTW, I may have had one of those headaches in this video… I apologize if I am less than bubbly today. Seriously.

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